Provider Demographics
NPI:1427330851
Name:MUNDAY, JERRY E (RPH)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:E
Last Name:MUNDAY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 KISHWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-5116
Mailing Address - Country:US
Mailing Address - Phone:815-967-9054
Mailing Address - Fax:815-967-8872
Practice Address - Street 1:1602 KISHWAUKEE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-5116
Practice Address - Country:US
Practice Address - Phone:815-967-9054
Practice Address - Fax:815-967-8872
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.030724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist